Discover the EACVI Textbook of Echocardiography 2nd edition
Chapter 9 Hand-held echocardiography Denis Pellerin, Nuno Cardim, and Christian Prinz Contents Summary 79 Rationale for using pocket-size hand-held echocardiography 79 Training 80 Advantages 80 Users 83 Work in progress 83 Limitations 83 Conclusion 83 References 84 Summary The concept has spread into the majority of medical equipment, recently making a step from laptop echocardiography  to pocket-size echocardiography. Pocket-size handheld echocardiography (PHE) is becoming part of the daily practice of cardiology services and internal medicine . The potential value of using PHE devices to improve medical education and patient care has prompted some medical schools to begin integrating training in the uses and indications of ultrasound into their undergraduate and postgraduate medical curricula. Multiple names have emerged including ‘Ultrasound Stethoscope in Cardiology’ [3,4], portable bedside ultrasound, the visual stethoscope of the twenty-first century, ultrasound-assisted physical examination, and PHE. PHE is a complement to physical examination and provides additional information at the point of care to determine the optimized course of treatment for patients. PHE does not provide a complete diagnostic echocardiographic examination and PHE studies are not reimbursed. For potential users other than cardiology experts in echocardiography the accuracy of PHE data is highly dependent on training and expertise. Echocardiography is an operator-dependent technique. Only specific training could reduce concerns of inappropriate data acquisition and interpretation, and patient safety. Acquisition of good quality images and knowledge of pitfalls and limitation are crucial. Rationale for using pocket-size hand-held echocardiography Examinations using PHE have been demonstrated to be feasible and provide additional information to physical examination. Currently, PHE offers diagnostic quality two-dimensional and colour Doppler imaging in real time. There are two PHE machines available on the market at present: Acuson P10 Siemens and Vscan GE Vingmed Ultrasound. Colour flow imaging is available in one product only with fixed colour box size and fixed pulse repetition frequency. Excellent correlation and agreement between PHE and conventional systems has been shown in the assessment of echo parameters when studies were performed by expert cardiac sonographers and experienced cardiologists [5,6]. Focused cardiac echocardiography
Chapter 10 Intracardiac and intravascular echocardiography Gilbert Habib, Carlo di Mario, and Guy Van Camp Contents Summary 85 Principles, methods, and main indications 85 Intracardiac echocardiography for monitoring of patent foramen ovale and atrial septal defect closure 86 Intracardiac echocardiography during electrophysiological interventions 86 Miscellaneous less well investigated possible indications 88 New developments of intracardiac echocardiography 88 The cost–benefit ratio of intracardiac echocardiography 88 Conclusion 88 References 88 Summary Intracardiac echocardiography (ICE) is a relatively young technique, nearly exclusively used for monitoring and guidance of interventional procedures [1–5]. Principles, methods, and main indications ICE needs a venous access using 8 or 9 F catheters. The most frequently used catheter is the 8 F AcuNav TM catheter (Siemens-Acuson, Inc., Mountain View, CA, USA), allowing the visualization of cardiac structures similar to that obtained with transoesophageal echocardiography (TOE). The technique needs a venous femoral access, after which the catheter is progressively advanced into the right atrium under a short fluoroscopic guidance. After obtaining the ‘home view’, a limited number of two-dimensional (2D) views can be obtained, including longitudinal and perpendicular views . However, the high image resolution obtained with ICE and the excellent visualization of the interatrial septum and the left atrium are the reasons why monitoring of atrial septal defect (ASD) closure and of electrophysiological interventions are the two main indications of the use of ICE. % Fig. 10.1 and % Video 10.1 illustrate the quality of images obtained with ICE in a patient with an ASD and the capacity of ICE to explore the different rims of the ASD. Of note, the inferior rim is better seen with ICE than with TOE . The main advantages of ICE are the direct visualization of intracardiac structures, particularly the ASD rims, the reduction of the time to radiation exposure, and the absence of need for general anaesthesia. Limitations of ICE include its invasive nature, the potential risk of vascular complications, and the 2D-only evaluation of the heart. However, recent technological advances, including real-time three-dimensional (3D) ICE, have been recently reported and are promising in the future . Other limitations include a relatively high cost, a limited availability, and a risk of transient atrial arrhythmia during the procedure. Other potential indications of ICE include interatrial septum puncture guidance, diagnosis of pacemaker lead endocarditis [8,9], and monitoring of percutaneous mitral commissurotomy and of transcatheter aortic valve implantation (TAVI). Indications of ICE are likely to increase with the development of catheter interventions, during which echocardiography is of utmost importance, that is, MitraClip® implantation, left atrial appendage closure, and percutaneous closure of paravalvular leaks .